title: Race and insurance status as risk factors for trauma mortality.
abstract: OBJECTIVE
  To determine the effect of race and insurance status on trauma mortality.
  
  
  METHODS
  Review of patients (aged 18-64 years; Injury Severity Score > or = 9) included in the National Trauma Data Bank (2001-2005). African American and Hispanic patients were each compared with white patients and insured patients were compared with uninsured patients. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, injury severity (Injury Severity Score and revised Trauma Score), severity of head and/or extremity injury, and injury mechanism.
  
  
  RESULTS
  A total of 429 751 patients met inclusion criteria. African American (n = 72,249) and Hispanic (n = 41,770) patients were less likely to be insured and more likely to sustain penetrating trauma than white patients (n = 262,878). African American and Hispanic patients had higher unadjusted mortality rates (white, 5.7%; African American, 8.2%; Hispanic, 9.1%; P = .05 for African American and Hispanic patients) and an increased adjusted odds ratio (OR) of death compared with white patients (African American OR, 1.17; 95% confidence interval [CI], 1.10-1.23; Hispanic OR, 1.47; 95% CI, 1.39-1.57). Insured patients (47%) had lower crude mortality rates than uninsured patients (4.4% vs 8.6%; P = .05). Insured African American and Hispanic patients had increased mortality rates compared with insured white patients. This effect worsened for uninsured patients across groups (insured African American OR, 1.2; 95% CI, 1.08-1.33; insured Hispanic OR, 1.51; 95% CI, 1.36-1.64; uninsured white OR, 1.55; 95% CI, 1.46-1.64; uninsured African American OR, 1.78; 95% CI, 1.65-1.90; uninsured Hispanic OR, 2.30; 95% CI, 2.13-2.49). The reference group was insured white patients.
  
  
  CONCLUSIONS
  Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.
authors.affiliation: Department of Surgery, Division of Trauma, Johns Hopkins Hospital, 600 N Wolfe St, Blalock 688, Baltimore, MD 21287, USA. ahaider1@jhmi.edu
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Marie
authors.initials: M
authors.lastname: Crandall
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D002423:Cause of Death; D003422:Critical Care / Q000191:economics / Q000592:standards; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011336:Probability; D011787:Quality of Health Care; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy